Attitudes towards neurology among medical undergraduates.

Diseases of the nervous system are an important contributor to clinical and social problems. Therefore there is a need to provide undergraduates and postgraduates of medical faculties with adequate training in neurology. However, many shortcomings have been observed in this field, often associated with students' negative perception of neurology. The aim of this study was to explore attitudes towards neurology amongst undergraduates of the medical faculty at Wroclaw Medical University, and the reasons for these attitudes. As a qualitative component of the study, a focus group discussion was conducted with six fifth year undergraduates. The findings of the focus group and a literature search informed the content of a questionnaire distributed among fifth year students of the medical faculty, including non-Poles attending English Division. The responses to the closed questions were analysed quantitatively and subjected to statistical analysis while the free text comments were analysed qualitatively. Triangulation of the findings from the focus group and the survey was performed. 134 Polish students and 75 English-speaking ones responded to the survey. The majority of participants perceived neurology to be interesting and important for medical education, and it was highly ranked as a potential future speciality. The majority of the survey respondents regarded neurology as difficult and mentioned specific drawbacks. In spite of similar general perceptions of neurology, Polish and English- -speaking students differed in their perceptions of particular aspects, conditioned by diversity in cultural backgrounds and earlier experiences associated with neurology. The course in neurology affected attitudes towards the subject more than preceding experiences, mostly in a positive manner. The fifth year medical undergraduates expressed mostly positive attitudes towards neurology. Cultural background and the course in neurology were the main factors contributing to attitudes in these students.

Media reporting of health interventions in New Zealand: a retrospective analysis.

AIM: To evaluate New Zealand media articles on their coverage of key issues regarding health interventions and whether it is consistent with available evidence. METHODS: A retrospective analysis was carried out of all articles published in five New Zealand media sources over a 6-week period between 15 October and 26 November 2014. Articles were included if their primary focus was on health interventions involving medications, devices or in-hospital procedures. Articles were assessed for coverage of key issues using previously validated 10-point criteria. A literature review was performed to compare content with scientific evidence. RESULTS: We identified 30 articles for review. Only 4 of 30 articles covered indications, benefits and risks, and of these, two were consistent with available evidence (7%, 95% CI 1%-22%). For articles that discussed at least one of indications, benefits or risks, and there was corresponding evidence available, there was a high level of consistency with the evidence (89%, 95% CI 77%-95%). The overall mean value of coverage from the 10-point criteria was 51% (95% CI 45%-58%). Single questions regarding the potential harm, costs associated with the intervention and the availability of alternative options were particularly poorly covered. They were rated as 'satisfactory' in 13%, 23% and 33% of the 30 articles respectively. CONCLUSION: New Zealand news articles covering medical treatments and interventions are largely consistent with available evidence but are incomplete. Vital information is being consistently missed, especially around the potential harms and costs of medical interventions.

Psychometric Properties of a Core Set of Measures of Balance for People With Cerebellar Ataxia Secondary to Multiple Sclerosis.

OBJECTIVE: To examine the reliability, validity, and interpretability of 4 clinical measures in assessing the severity of balance dysfunction among people with cerebellar ataxia (CA) secondary to multiple sclerosis (MS). DESIGN: Cross-sectional observation study. SETTING: Outpatient clinics. PARTICIPANTS: Consecutive participants with CA secondary to MS (N=60). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Balance was assessed and video recorded using the Berg Balance Scale (BBS), timed Up and Go (TUG) test, posture and gait subcomponent of the International Co-operative Ataxia Rating Scale (ICARS), and gait, stance, and sit subcomponents of the Scale for the Assessment and Rating of Ataxia (SARA). The videos were later used to estimate reliability. The Barthel Index, Expanded Disability Status Scale (EDSS), ICARS, and SARA were assessed, and disease duration was recorded. RESULTS: Reliability was good for all 4 measures (intraclass correlation coefficient range, .95-.99). Internal consistency was moderate to good for all 4 measures (α range, .72-.94), with a moderate to good correlation between the measures of balance (Spearman ρ range, .72-.85) and poor to moderate correlation with disease severity (EDSS), functional independence (Barthel Index), and disease duration (Spearman ρ range, -.37 to .76). Minimal detectable change was derived for the BBS (3), posture and gait subcomponent of the ICARS (2), and gait, stance, and sit subcomponents of the SARA (2). Measures were able to discriminate between assistive walking device users and nonusers. CONCLUSIONS: All 4 measures showed good reliability and acceptable validity; however, because of the item repetition in scoring of the posture and gait subcomponent of the ICARS and moderate construct, criterion, and convergent validity of the TUG, the BBS and gait, stance, and sit subcomponents of the SARA are recommended for balance assessment in clinical practice for people with CA secondary to MS.

Clinical features and natural history of neuroferritinopathy caused by the FTL1 460InsA mutation.

Neuroferritinopathy is a progressive potentially treatable adult-onset movement disorder caused by mutations in the ferritin light chain gene (FTL1). Features overlap with common extrapyramidal disorders: idiopathic torsion dystonia, idiopathic Parkinson's disease and Huntington's disease, but the phenotype and natural history have not been defined. We studied a genetically homogeneous group of 41 subjects with the 460InsA mutation in FTL1, documenting the presentation, clinical course, biochemistry and neuroimaging. The mean age of onset was 39.4 years (SD = 13.3, range 13-63), beginning with chorea in 50%, focal lower limb dystonia in 42.5% and parkinsonism in 7.5%. The majority reported a family history of a movement disorder often misdiagnosed as Huntington's disease. The disease progressed relentlessly, becoming generalized over a 5-10 year period, eventually leading to aphonia, dysphagia and severe motor disability with subcortical/frontal cognitive dysfunction as a late feature. A characteristic action-specific facial dystonia was common (65%), and in 63% there was asymmetry throughout the disease course. Serum ferritin levels were low in the majority of males and post-menopausal females, but within normal limits for pre-menopausal females. MR brain imaging was abnormal on all affected individuals and one presymptomatic carrier. In conclusion, isolated parkinsonism is unusual in neuroferritinopathy, and unlike Huntington's disease, cognitive changes are absent or subtle in the early stages. Depressed serum ferritin is common and provides a useful screening test in routine practice, and gradient echo brain MRI will identify all symptomatic cases.

New Zealand's neurologist workforce: a pragmatic analysis of demand, supply and future projections.

AIMS: To estimate current and future specialist neurologist demand and supply to assist with health sector planning. METHODS: Current demand for the neurology workforce in New Zealand was assessed using neuroepidemiological data. To assess current supply, all New Zealand neurology departments were surveyed to determine current workforce and estimate average neurologist productivity. Projections were made based on current neurologists anticipated retirement rates and addition of new neurologists based on current training positions. We explored several models to address the supply-demand gap. RESULTS: The current supply of neurologists in New Zealand is 36 full-time equivalents (FTE), insufficient to meet current demand of 74 FTE. Demand will grow over time and if status quo is maintained the gap will widen. CONCLUSIONS: Pressures on healthcare dollars are ever increasing and we cannot expect to address the identified service gap by immediately doubling the number of neurologists. Instead we propose a 12-year strategic approach with investments to enhance service productivity, strengthen collaborative efforts between specialists and general service providers, moderately increase the number of neurologists and neurology training positions, and develop highly skilled non-specialists including trained.

Corneal topography matching by iterative registration.

Videokeratography is used for the measurement of corneal topography in overlapping portions (or maps) which must later be joined together to form the overall topography of the cornea. The separate portions are measured from different viewpoints and therefore must be brought together by registration of measurement points in the regions of overlap. The central map is generally the most accurate, but all maps are measured with uncertainty that increases towards the periphery. It becomes the reference (or static) map, and the peripheral (or dynamic) maps must then be transformed by rotation and translation so that the overlapping portions are matched. The process known as registration, of determining the necessary transformation, is a well-understood procedure in image analysis and has been applied in several areas of science and engineering. In this article, direct search optimisation using the Nelder-Mead algorithm and several variants of the iterative closest/corresponding point routine are explained and applied to simulated and real clinical data. The measurement points on the static and dynamic maps are generally different so that it becomes necessary to interpolate, which is done using a truncated series of Zernike polynomials. The point-to-plane iterative closest/corresponding point variant has the advantage of releasing certain optimisation constraints that lead to persistent registration and alignment errors when other approaches are used. The point-to-plane iterative closest/corresponding point routine is found to be robust to measurement noise, insensitive to starting values of the transformation parameters and produces high-quality results when using real clinical data.